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​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​CalAIM Intermediate Care Facility for Developmentally​ Disabled Long-Term Care Carve-In

​Return to CalAIM Long-Term Care Carve-in Transition

Under CalAIM, the Intermediate Care Facility for Developmentally Disabled (ICF/DD) transition to Medi-Cal managed care is intended to standardize ICF/DD services covered under managed care statewide, advance a more consistent and integrated system of managed care, and increase access to comprehensive care coordination, care management, and a broad array of services for Medi-Cal members in ICF/DD Homes (including habilitative and nursing).  

January 1, 2024 Transition  

Effective January 1, 2024, all Medi-Cal managed care plans (MCPs) became responsible for covering the following ICF/DD services: 

 

  • ​ICF/DD
  • ICF/DD-Habilitative (ICF/DD-H)​
  • ICF/DD-Nursing (ICF/DD-N)

 

Note: ICF/DD-Continuous Nursing Care (ICF/DD-CN) Homes are not subject to the Long Term Care (LTC) Carve-In policy.  

As of January 1, 2024, all residents of ICF/DD, ICF/DD-H, and ICF/DD-N Homes have transitioned from Fee-For-Service (FFS) Medi-Cal to Medi-Cal managed care. The ICF/DD Carve-In does not affect current payment rates that ICF/DD Homes (including habilitative and nursing) receive and the scope of the services under the ICF/DD benefit remains the same.  

DHCS, in partnership with the California Department of Developmental Services (DDS), worked closely with the ICF/DD stakeholder workgroup to finalize policies and resources related to this ICF/DD Carve-In from FFS Medi-Cal to Medi-Cal managed care. All resources can be found under “Key Documents” section. As new or updated resources are published, they will be highlighted in the “Important Updates” section. 

​​Important Updates​​​

All Plan Letter and Frequently Asked Questions – Updated September/October 2024

In September 2024, DHCS released APL 24-011: ICF/DD – LTC Benefit Standardization and Transition of Members to Managed Care, which supersedes APL 23-023. The revised APL clarifies requirements for authorization timelines, Share of Cost, and processes for implementing updated Medi-Cal FFS per diem rates. In October 2024, DHCS issued an updated ICF/DD Frequently Asked Questions (FAQs) document to further clarify updates made in the revised APL. The revised APL 24-011, including the APL's attachments (MCP ICF/DD Authorization Request Form and ICF/DD Credentialing Attestation Form), and FAQs can be found under Key Documents.​

LTC Learning Series

DHCS is hosting an LTC Learning Series during Fall 2024. The LTC Learning Series consists of a series of educational webinars for Medi-Cal MCPs and LTC providers. The content presented in these webinars has been shaped by stakeholder feedback with the goal of enhancing MCPs', LTC providers', and interested stakeholders' understanding of Medi-Cal managed care and LTC. Each session covers different topics tailored to its intended audience. Details are included under “Informational Webinars" below. 

 

Regional Center Payment Assistance Extension

Regional Centers are providing payment assistance, also referred to as lag funding, for ICF/DD Home providers if they experience delays in receiving reimbursement from MCPs during the ICF/DD Carve-In transition. In an update released on October 3, 2024, DDS announced that the availability of lag funding has been extended until June 30, 2025. More details about the extension, attestation forms, and other resources can be found on the DDS Regional Center Directive website​.

 

Billing and Invoicing Guidance

DHCS has developed guidance on billing and invoicing in response to a consensus within the stakeholder community that some flexibility is needed in the processes ICF/DD Homes will use for billing their MCP. The guidance defines the necessary data elements for billing and invoicing, as well as standards for file formats, transmission methods, submission timing, and adjudication. This guidance document can be found under Key Documents.

​​Information for Members

 

DHCS worked closely with stakeholders, ICF/DD Homes, and Medi-Cal MCPs to develop member notices and other resources designed to ensure a seamless transition for members living in an ICF/DD Home whose coverage will transition from FFS Medi-Cal to Medi-Cal Managed Care.  

T​he ICF/DD LTC Member Enrollment Notices and other resources for members are available on the ICF/DD Carve-In Member Information webpage. ​

ICF/DD Carve-in Guiding Principles

The transition of ICF/DD services from FFS Medi-Cal to Medi-Cal managed care should be seamless for members. This means no disruption in access to care or services, that MCPs conduct timely review and authorization of services, as well as support the member's care planning. In addition, the existing infrastructure (e.g., Regional Centers, ICF/DD Home model) for individuals with developmental disabilities will stay the same, which includes Lanterman Act protections and the roles and responsibilities of Regional Centers. 

DHCS shared drafts and obtained input from the Workgroup on the following deliverables:

  • Provider notifications
  • Medi-Cal member notifications
  • ICF/DD Promising Practices/FAQ document
  • APL which serves as requirements to MCPs
  • Standard Provider Contract Guidance

ICF/DD Informational Webinars

To support stakeholder planning and implementation, DHCS is hosting an educational webinar series. Details and materials for each webinar can be found below.​

Upcoming Webinars

Past Webinars ​

 

LTC Learning Series: Managed Care Resources for LTC Providers: December 17, 2024 at 9:00 a.m.

 

​​​LTC Learning Series: LTC Policy Update: November 4, 2024 at 11:00 a.m.

 

ICF/DD Carve-In Office Hours: Thursday, April 25, 2024 at 10:30 a.m.

 

ICF/DD Carve-In Office Hours: Friday, March 22, 2024 at 2:00 p.m.

ICF/DD Carve-In Office Hours: Wednesday, February 28, 2024 at 3:00 p.m.

 

ICF/DD Carve-In Office Hours: Wednesday, January 24, 2024 at 11:00 a.m. 

 

​​​​How Medi-Cal Managed Care Supports Subacute Care Facility and ICF/DD Home Residents: December 15, 2023 at 9:00 a.m.

 

ICF/DD Office Hours: Friday, December 1, 2023 at 1:00 p.m.  ​

ICF/DD Carve-In Billing & Payment: Friday, November 17, 2023 at 1:00 p.m.  ​

ICF/DD Carve-In Promising Practices: Friday, October 6, 2023 at 9:30 a.m.  ​

 

​ICF/DD Carve-In Office Hours: Friday, September 8, 2023 at 10:00 a.m.  ​

 

​ICF/DD Carve-In 101 for ICF/DD Homes: Monday, August 21, 2023 at 2:30 p.m.  

​ICF/DD 101 for MCPs: Wednesday, July 12, 2023  at 10:00 a.m.  

​ICF/DD Carve-In Workgroup​​​​​ Meetings

​Welf​are and Institutions Code (WIC) Section 14184.201 required DHCS and DDS to convene a workgroup to address the transition of ICF/DD services from the FFS Medi-Cal delivery system to the Medi-Cal managed care delivery system. The goal of this effort was to​ work towards a seamless transition for residents of ICF/DD Homes to Medi-Cal managed care. DHCS and DDS convened the ICF/DD Workgroup from March 2022 through February 2024 to provide an opportunity for stakeholders to collaborate and provide advisory feedback on DHCS' policy and operational efforts in carving in ICF/DD services into Medi-Cal managed care. Workgroup participants include representatives from Regional Centers, MCPs, ICF/DD Homes and affiliated associations, consumer groups and the Service Employees International Union (SEIU). The ICF/DD Workgroup focused on issues specific to Medi-Cal members with developmental disabilities, the Homes and providers who serve these individuals.

2022​​​

2023
2024

​Additional Resources

Listed below are additional resources:

Questions a​nd Co​​mments

Contact DHCS with any questions or comments about the ICF/DD Carve-In Transition at LTCTransition@dhcs.ca.gov​.​

Last modified date: 2/24/2025 5:09 PM